Coronary artery anomalies represent about 0.64% to 1.3% of patients undergoing coronary angiography. Нe OeÑ– anterior descending coronary arteries (LADs) have rare variations in origin, course, and distribution, also the right coronary artery fairly shows such anomalous variations. Approximately 1% of Morettin’s cases were reported to show complete duplication of a coronary artery or one of its branches. Demonstration of the Dual LAD anomaly and consideration of strategic approach when dealing with CTO in one branch of that anomaly. Our case is a female patient 54 years old diabetic, hypertensive and dyslipidemic on oral hypoglycemic, statins, Beta Blockers and aspirin, she presented to our clinic complaining from typical chest pain and minor ECG changes, cardiac markers was negative for 2 sets. Because of her high risk proÙ½Oe we advised to do Coronary angiography.